Shots - Health Blog

1:25 pm

Mon March 26, 2012

Weight-Loss Surgery May Help Treat, Even Reverse, Diabetes

Cristina Iaboni, a diabetic, underwent gastric bypass surgery at New York-Presbyterian/Weill Cornell in the fall of 2009 as part of a study. After losing 50 pounds, her blood sugar was nearly normal. She is pictured here in June 2010.

Thomas CainAP

Surgical procedures that are commonly used to help obese people lose weight can also dramatically improve — even reverse — diabetes, according to two studies released Monday.

Tim Ferree of Macedonia, Ohio, struggled with his weight for years. He knew his out-of-control blood sugar would eventually cause serious problems.

So when Ferree heard about an operation that might help with his weight and his diabetes, he volunteered to get it.

"With a brand new baby in the house, that's really what prompted me to take a very aggressive course towards treating the diabetes," he said.

Surgeons have been operating on obese people for years, making their stomachs smaller and rearranging their digestive systems. Doctors realized that patients who got the operations also often had their diabetes get much better. Sometimes it even went away completely. But they didn't have good research that proved surgery was really effective.

"What's been lacking is a head-to-head comparison of surgery versus some of the newer anti-diabetic drugs," said Philip R. Schauer of the Cleveland Clinic, who led one of the studies. The second was conducted in Rome and led by Francesco Rubino of Weill Medical College of Cornell University. Both studies involved patients with Type 2 diabetes, which is the most common form of the disease.

The results showed that patients who got the operations were much more likely to have their blood sugar go down. Many were able to stop taking any diabetes drugs altogether.

"Just the fact we were able to see this many people achieve normal blood sugar without medications is somewhat astonishing. In a sense, we're reversing the disease," Schauer.

After the surgery, patients would sometimes get better within hours or days. And when that happens it's clear there's something more going on than just the effects of getting thinner. One theory is that re-arranging the digestive system affects important hormones.

"There appears to be an increased production of special hormones from the intestinal tract and these hormones are known to directly stimulate the pancreas to make more insulin," Schauer said.

This research raises an important question: Should diabetics start getting this operation more often? Paul Zimmet of the International Diabetes Federation, who co-authored an editorial accompanying the studies, thinks they should.

"Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is seen as a last resort. And it should be offered earlier in management," Zimmet said in a telephone interview.

But others aren't so sure. The new studies followed only about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

"I think we need longer-term follow-up than what was done in these studies to make sure you're not trading one problem for another," said Vivian Fonseca of the American Diabetes Association.

For his part, Ferree is thankful. He's 60 pounds lighter. He's off all his drugs — not only for his diabetes, but also for blood pressure and cholesterol.

"I'm not staring down the barrel of being diabetic. I'm not looking at a future of potentially having to give myself several insulin shots every day," Ferree said. "I'm not potentially looking at, you know, losing a foot or losing my eyesight or having a stroke. That's a great relief for anyone."

Researchers are now testing whether the surgery works on diabetics who aren't even obese — people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

We've been hearing about health care law. Now, simply health care. Two studies released today address options for diabetics. They have found that surgical procedures commonly used to help obese people lose weight can also dramatically improve or even reverse diabetes.

That may offer an alternative treatment for diabetics, as NPR's Rob Stein explains.

ROB STEIN, BYLINE: Diabetes is one of the nation's biggest health problems and the disease is often caused by obesity. Diabetic Tim Ferree of Macedonia, Ohio, struggled with his weight for years. He knew his out-of-control blood sugar would eventually cause serious problems.

STEIN: So when Ferree heard about an operation that might help with his weight and his diabetes, he volunteered to get it.

FERREE: With a brand new baby in the house, that's really what prompted me to take a very aggressive course towards treating the diabetes.

STEIN: Surgeons have been operating on obese people for years, making their stomachs smaller and rearranging their digestive systems. And doctors realized that patients who got the operations often had their diabetes get much better. Sometimes it even went away completely. But they didn't have good research that proved surgery was really effective.

DR. PHILIP SCHAUER: What's been lacking is a head-to-head comparison of surgery versus some of the newer anti-diabetic drugs.

STEIN: That's Philip Schauer of the Cleveland Clinic. He led one of the studies released today. The results showed that patients who got the operations were much more likely to have their blood sugar go down. Many were able to stop taking any diabetes drugs altogether.

SCHAUER: Just the fact we were able to see this many people achieve normal blood sugar without medications is somewhat astonishing. In a sense, we're reversing the disease.

STEIN: After the surgery, patients would sometimes get better within hours or days. And when that happens, it's clear there's something more going on than just the effects of getting thinner. One theory is that rearranging the digestive system affects important hormones.

SCHAUER: There appears to be an increased production of special hormones from the intestinal tract. And these hormones are know to directly stimulate the pancreas to make more insulin.

STEIN: And insulin controls blood sugar levels. This research raises an important question: Should diabetics start getting this operation more often? It's called bariatric surgery. Paul Zimmet of the International Diabetes Federation thinks they should.

DR. PAUL ZIMMET: Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is being seen as a last resort. And it should be offered earlier in management.

STEIN: But others aren't so sure. The new studies only followed about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

Vivian Fonseca is the top scientist at the American Diabetes Association.

DR. VIVIAN FONSECA: I think we need longer-term follow-up than what was done in these studies, to make sure that you're not trading one problem for another.

STEIN: For his part, Tim Ferree is thankful. He's 60 pounds lighter. He's off all his drugs - not only for diabetes, but also for blood pressure and cholesterol.

FERREE: I'm not staring down the barrel of being diabetic. I'm not looking at a future of potentially having to give myself several insulin shots every day. I'm not potentially looking at, you know, losing a foot or losing my eyesight or having a stroke. That's a great relief, I think, for anyone.

STEIN: Researchers are now testing whether the surgery works on diabetics who aren't even obese - people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.